Re: One layer uterine closure
From: art fougner, md (evsono@pipeline.com)
Sun Sep 3 09:07:58 2006
A saline sonohysterogram done at say 8 - 12 weeks post partum to
evaluate the uterine scar might provide some useful clues to the
benefits of any technique. I would suggest incorporation of this
procedure into any prospective trial on uterine closure technique. I
know Ashley has experience with this procedure ... what say you?
Art
At Sat, 2 Sep 2006, Kokumo Oyakhire wrote:
>
>My patients and I would prefer the time honoured two layered unlocked closure. I do not mind change(s), but any change in practice should have gone through ethically approved researches, at least controlled trials. Even the SPCAs still protect there patients.
>
>"D. Ashley Hill" <dahmd@cfl.rr.com> wrote: Heresy. Actually, I have not locked uterine incisions for over 12 years
>(you have me beat by a long shot) due to concerns about tissue necrosis.
>Everyone asks "what about hemostasis." If you observe the tissue after
>you have completed with your incision line it's obvious if it's bleeding
>or not (usually not). What's equally interesting to me is the variety
>of suture material. I know someone who uses 3-0 vicryl for the uterus,
>whereas I use 0-chromic. I guess we're all victims of our training.
>
>Ashley
>
>At Fri, 1 Sep 2006, R. Daniel Braun wrote:
>>
>>One needs to ask are these ONE layer LOCKING sutures or one layer NO-LOCKING
>>sutures?
>>I bet the bad results were with locking and the good ones with non-locking.
>>
>>Just my opinion and over 40 years observation.
>>
>>Dan
>>
>>On 9/1/06, Dr. Cesar Molina wrote:
>>>
>>> I am a obstetric and gynecologyc surgeon in Costa Rica and have two
>>> experiences with one layer uterine closure. For differente
>>> circumstances I have to open this patients 7 and 8 days after the
>>> section. It was very impressionant the irregular and bad aspect of
>>> uterine scarr healing in two cases. Although the inmediate evolution
>>> of the patients was good after reintervention(late evolution I don`t
>>> know), I felt very much concerned about the future evolution of their
>>> abdominal cavities. My impression was that this two patiens will
>>> depelop an important adherential syndrome. What is your experience
>>> about??
>>>
>>> At Sun, 10 Jun 2001, art fougner, md wrote:
>>> >
>>> >germans had an entirely different experience -
>>> >
>>> >1: Zentralbl Gynakol 1986;108(17):1039-45
>>> >
>>> >[Clinical experiences with a single layer uterine suture in cesarean
>>> >section].
>>> >
>>> >[Article in German]
>>> >
>>> >Winkler M, Ruckhaberle KE, Saul S, Forberg J.
>>> >
>>> >In this analysis 536 caesarean sections with a single layer uterine
>>> >suture were compared to 256 sections with two layer closure. Their
>>> >relations with regard to indications of operative delivery,
>>> >complications during the puerperium and their courses in subsequent
>>> >vaginal deliveries were taken into consideration. - The significant
>>> >lower rate of pyrexia and shorter hospital stay of the patients may be a
>>> >result of quicker and better healing of the single layer suture. The
>>> >increased rate of complications in the puerperium is partially due to
>>> >changes in the registry of dates. Absent disturbances during the
>>> >placental period and the occurrence of only one uterine rupture, in the
>>> >course of vaginal delivery in a patient with a previous single layer
>>> >caesarean section suture, demonstrates the functional sufficiency of
>>> >this technic.
>>> >
>>> >PMID: 3538711 [PubMed - indexed for MEDLINE]
>>> >
>>> >seems reasonable to perform a formal trial.
>>> >
>>> >art
>>> >
>>> >At Sun, 10 Jun 2001, Steve Raymond wrote:
>>> >>
>>> >>Yes, and we are considering enrolling, but we had an experience about
>>> four years
>>> >>ago when one of the rural hospitals that refers to us decided to start
>>> one layer
>>> >>closures after reading about the Misgav-Ladach technique. We found after
>>> a few
>>> >>months that they were suddenly sending us problem cases of bleeding and
>>> failure
>>> >>of healing and such like, which had us mystified until they informed us
>>> of the
>>> >>change in technique, of which we had not previously been aware.
>>> >>
>>> >>Seems to me that they should have an ethical committee ruling on this!
>>> >>stray
>>> >>
>>> >>> The CAESAR study is recruiting in UK, is it not?
>>> >>>
>>> >>> Rupak Ranjan Roy
>>> >>> MRCOG
>>> >>
>>> >>--
>>> >>
>>> >>Dr.S.H. Raymond
>>> >>Head of Department of O & G
>>> >>Empangeni Hospital
>>> >>South Africa 3880
>>> >>Phone: (+27) 35-7721111
>>> >>Fax: (+27) 35-7922596
>>> >>
>>> >--
>>> >art fougner, md
>>> >
>>> >A series of 1000 cases begins with but a single anecdote.
>>> >
>>>
>>--
>>R. Daniel Braun
>>
>> "The way to health is an aromatic bath and scented massage everyday".
>> Hippocrates
>>
>--
>D. Ashley Hill, MD
>Associate Director
>Department of Obstetrics and Gynecology
>Florida Hospital Family Practice Residency
>Medical Director, Loch Haven Ob/Gyn Group
>Division Director, Dept. of Ob/Gyn, Florida Hospital Orlando
>Orlando, Florida
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
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